Illuminated telescoping cannula

ABSTRACT

The illumination system described below comprises an arthroscope, endoscope or other suitable surgical tool and an attachable cannula comprising a transparent or semi-transparent material capable of carrying light from the proximal end of the cannula to the distal end of the cannula, thereby illuminating the surgical field. The surgical field is thus illuminated through components that do not occupy space that may otherwise be used for the optics of the arthroscope. The arthroscopic illumination system further comprises one or more illumination sources disposed at the proximal end of the cannula. The illumination source may be optically coupled with the cannula at the hub or other appropriate location. The cannula comprises a sterilizable polymer which functions as a waveguide. A waveguide is a material medium that confines and guides light. When in use, the light source connected to the hub provides light which may be guided to the distal end of the cannula or any other suitable location. Thus, the sheath provides structure-guided illumination resulting in the illumination of the surgical site.

CROSS-REFERENCE

The present application is a continuation of U.S. patent applicationSer. No. 15/384,821 (Attorney Docket No. 40556-705.309) filed Dec. 20,2016, which is a continuation of U.S. patent application Ser. No.14/635,996 (Attorney Docket No. 40556-705.305), filed Mar. 2, 2015,which is a continuation of U.S. patent application Ser. No. 12/188,055(Attorney Docket No. 40556-705.502) filed Aug. 7, 2008 now U.S. Pat. No.9,005,115, which is a continuation in part of U.S. patent applicationSer. No. 11/715,247 (Attorney Docket No. 40556-705.501) filed Mar. 6,2007 now U.S. Pat. No. 7,901,353 which is a continuation in part of U.S.patent application Ser. No. 11/397,446 (Attorney Docket No.40556-705.201) filed Apr. 3, 2006 now U.S. Pat. No. 7,510,524 which is anon-provisional of, and claims the benefit of US Provisional PatentApplication Nos. 60/724,717 (Attorney Docket No. 40556-706.101) filedOct. 7, 2005, and 60/668,442 (Attorney Docket No. 40556-705.101) filedApr. 4, 2005; the entire contents of each of which is incorporatedherein by reference.

FIELD OF THE INVENTIONS

The present invention relates generally to the field of surgicalillumination and more specifically to surgical cannulas providingillumination.

BACKGROUND OF THE INVENTION

Currently optical fiber illumination elements such as element 12 shownin FIG. 1 are used exclusively in medical illumination where smallpackaging is critical. Although the cost of raw glass or plastic fiberis relatively inexpensive, the cost of assembling the fiber into anendoscope tube or other surgical device may be high. Once the fiber isinserted, it generally must be glued and polished to a specific angle.Optical fiber is also extremely fragile and brittle. During the assemblyprocess or in the field after many sterilization cycles, optical fiberand other conventional waveguide plastics may start to break down anddegrade. Color change is also very common with fiber optics after manysterilization cycles. Since the fiber is integrated into a medical tool,any damage to the fiber optics also results in damage to the tool, thuscausing an expensive overhaul. The relatively small size of the distalend of an illumination fiber also makes obscuration by blood or othermaterial in a surgical site very likely and thus hinders to efficientsurgery.

Another significant challenge in many conventionally illuminatedprocedures is cable management. There may be many cables typicallypresent in the sterile field: camera cable, fiber optic cable,irrigation and suction, etc. Since the optical fiber cable has thelargest diameter it typically is the heaviest cable. One of thechallenges that face surgeons using illuminated tools is constantrotation of the illuminated tool to view different orientation angles.When an illuminated tool is rotated, the fiber optic cable is forced torotate around with the tool, thus causing interference. These issuesbecome even more important during arthroscopic surgery. Since theoptical fiber cable is heavy, it will actually rotate the endoscope,often forcing the surgeon to keep one of their hands on the fiber opticcable to prevent unwanted spinning of the endoscope.

The illumination fiber also occupies space inside an illuminated tool,an endoscope or other surgical implement. By allocating space to opticalfiber illumination, the diameter of optics may be limited to maintainthe smallest overall tool size.

Typical coupling surfaces to a fiber optic cable are circular, mainlybecause the fiber cable itself is made with circularly bundled fibers.The problem is accounting for the various sizes of fiber bundles (e.g.,3.0 mm, 3.5 mm, 4 mm, 5 mm diameter bundles are common) to which a lightconducting or light guiding device, also called a waveguide device, maybe coupled in order to optimize coupling efficiency. Light that is notcoupled from the fiber into the waveguide is lost light that cannot beused for illumination. In addition, this lost light may have infraredcomponents that contribute to heating of the coupling connectors, whichare typically metal in fiber optic cables. This heating may besignificant enough to cause minor to major burns.

SUMMARY

An illuminated cannula port combines an illuminated waveguide cannula beformed to have thin walls with a thin walled cannula sleeve of metal orother suitable material to achieve tissue retraction to create asurgical site and deliver illumination to the surgical site from thebottom of the waveguide cannula within the cannula sleeve. The cannulasleeve may be longer than the waveguide cannula. The waveguide cannulaand the cannula sleeve are separate pieces and are free to move relativeto each other to provide a wide range of cannula port lengths using therelative telescoping movement between the waveguide cannula and thecannula sleeve.

The waveguide sleeve may have many different geometries as, for example,a right circular cylinder, or the bottom edge may have any suitableangle relative to the axis of the sleeve bore to prevent tissue creep.The ability to move the waveguide cannula and the cannula sleeverelative to each other enables a surgeon to move the sleeve toaccommodate tissue requirements without the need to move theillumination cable and the waveguide cannula. Similarly, if the surgeonslight needs vary during the surgery, it is possible to move theillumination cable and the waveguide cannula without changing theposition of the cannula sleeve.

An illuminated waveguide cannula as a single unit that may be moldedinto custom shapes and or made single use disposable. If the waveguideis single use and sold sterile, it will be brand new for everyapplication, so if any damage occurs during a procedure, the waveguidemay be easily replaced and may be discarded after a procedure.

A surgical illumination system according to the present disclosure mayinclude a generally cylindrical light waveguide having a bore sized toaccommodate one or more surgical instruments, an illumination source, anillumination conduit for conducting illumination energy from theillumination source, and an adapter ring for engaging the illuminationconduit and coupling illumination energy from the illumination conduitto the light waveguide, the adapter ring permitting relative movementbetween the illumination conduit and the light waveguide.

A surgical illumination system may also include an illumination source,a generally cylindrical light waveguide having a distal end and aproximal end and a bore sized to accommodate one or more instruments ortools extending from the proximal end through the distal end, thewaveguide conducting illumination energy from the proximal end to thedistal end and projecting the illumination energy from the distal end,and an illumination conduit for conducting illumination energy from theillumination source to the proximal end of the light waveguide. Asecondary cannula may be combined with the waveguide cannula to providemechanical retraction and enable the waveguide cannula to be rotatedrelative to the secondary cannula as well as providing adjustable depth.

Since multiple ports are commonly used in endoscopy and, typically, acannula or trocar is placed at each port, one or more of the portcannulas or port trocars could be a waveguide designed to spread lightin the desired direction in one embodiment. Use of illuminated cannulaor waveguides enables the light to shine circumferentially from the portcannula or can make it shine in a particular direction from the portcannula. The intensity of light may be adjusted circumferentially tomaximize shadow creation, for example, by concentrating extractionstructures along a particular arc of the port cannula and using lessconcentrated extraction structures along another arc and having nostructures on the remaining arc, or using less concentrated structuresalong the remaining arc. Directionality can be simply controlled byrotating the port cannula to shine the higher intensity light tomaximize shadowing. Another option is to put a rotatable reflector ordirector partially around the waveguide or otherwise adjustably engagedwith the waveguide. Light from the waveguide, e.g., a waveguideproducing light circumferentially, is reflected and or directed by thisreflector/director, e.g., a mirror-polished metal or plastic componentor a component with a reflective film, in a particular direction. Theuser merely rotates the reflector/director rather than rotating thewaveguide itself, which may be cumbersome with a fiber optic cableattached to the waveguide.

In another configuration, a small “chandelier” waveguide may be placedvertically or at a particular angular orientation to the interior worksurface using a very small puncture wound that is separate from the mainsurgical ports. This chandelier waveguide may provide circumferential ordirected light and may include a secondary reflector/director asdescribed above. The waveguide may be protected during insertion byusing an introducer that goes over the waveguide, said introducer havinga sufficiently sharp point to create the wound or the surgeon creates asmall wound for the introducer to go into. Once the introducer andwaveguide are in place, the introducer is slid back up the waveguide toexpose the light extraction structures. This can be accomplished, forexample, by creating the point of the introducer out of a set of radialsplines that are curved and shaped to form a point or blunt tip forinsertion into the wound. Once in place, the introducer is pulled outand the splines spread out over the waveguide. Alternatively, theintroducer and reflector/director are the same component and remain inplace after insertion into the wound to provide directional lightcontrol. Output from the chandelier waveguide may be combined with lightfrom instrument ports that are also designed as waveguide devices, orthemselves may use the waveguide ports.

The surgical illumination systems may also be distributed pre-sterilizedalong with one or more generally used instruments and accessory partsthat may be used by most surgeons. Thus a sterile waveguide may besupplied for a surgery and discarded after use minimizing parts to bereused, inventoried and resterilized.

These and other features and advantages will become further apparentfrom the detailed description and accompanying figures that follow. Inthe figures and description, numerals indicate the various features ofthe disclosure, like numerals referring to like features throughout boththe drawings and the description.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 is a perspective view of the distal end of a conventionalendoscope.

FIG. 2 is a perspective view of the distal end of an endoscope with anoptical waveguide sheath according to the present disclosure.

FIG. 3 is a perspective view of the distal end of an optical waveguidesheath according to the present disclosure.

FIG. 4 is an end view of the distal end of an optical waveguide sheathaccording to the present disclosure.

FIG. 5 is a side view of an optical waveguide sheath coupling to fiberoptic elements.

FIG. 6 is an end view of the fiber optic coupling lens array of FIG. 5.

FIG. 7 is a side view of an optical waveguide sheath with alight-coupling adapter according to the present disclosure.

FIG. 8 is a side view of an optical waveguide illumination system with ahigh-resolution arthroscope disposed therein.

FIG. 9 is a side perspective view of an alternate optical waveguidelight coupling technique.

FIG. 10 is an end view of the optical waveguide of FIG. 9.

FIG. 11A is a cutaway view of the proximal end of an optical waveguidewith another alternate light coupling.

FIG. 11B is an end view of an optical waveguide of FIG. 11A.

FIG. 11C is a cutaway view of the proximal end of the optical waveguideof FIG. 11B taken along B-B.

FIG. 12 is a perspective view of an optical waveguide with yet anotherinput light coupling.

FIG. 13 is an enlarged perspective view of the distal end of an opticalwaveguide.

FIG. 14 is a cutaway view of an alternate optical waveguide.

FIGS. 14a-14d are cutaway views of alternate distal ends of the opticalwaveguide of FIG. 14.

FIG. 15 is a perspective view of an optical waveguide with an alternatelight coupling.

FIG. 16 is a cutaway view of the proximal end of the optical waveguideof FIG. 15.

FIGS. 17a-17c are front views alternate distal ends of the lightcoupling of FIG. 15.

FIG. 18 is a perspective view of an optical waveguide with a split inputcoupling.

FIG. 19 is cutaway view of the optical waveguide of FIG. 18.

FIG. 20 is and cross-section of the optical waveguide of FIG. 18 takenalong B-B.

FIG. 21 is a perspective view of an alternate optical waveguide with asplit input coupling.

FIG. 22 is a perspective view of another alternate optical waveguidewith a split input coupling.

FIG. 23 is a cross section of the distal end of an optical waveguide.

FIG. 24 is a cross-section of the distal end of an alternate opticalwaveguide.

FIG. 25 is a perspective view of an alternate optical waveguide with areinforced and shielded split input coupling.

FIG. 26 is a cutaway view of the optical waveguide of FIG. 25.

FIG. 27 is a perspective view of the optical waveguide of FIG. 25 withthe clamp assembly removed for clarity.

FIG. 28 is a side view of the optical waveguide of FIG. 27.

FIG. 29 is a cutaway perspective view of an optical waveguide with theclamp assembly removed for clarity.

FIG. 30 is a close up front view of the input connector of FIG. 29.

FIG. 31 is a cutaway view of the optical waveguide of FIG. 25 with aventilation path added.

FIG. 32 is a perspective view of a ventilation controller.

FIG. 33 is a perspective view of an alternate ventilation controller.

FIG. 34 is a cross-section of a light coupling for the optical waveguideof FIG. 25.

FIG. 35A is a cross-section of an alternate light coupling for theoptical waveguide of FIG. 25.

FIG. 35B is a cross section of the alternate light coupling of FIG. 35Ataken along C-C.

FIG. 36A is a perspective view of an ear speculum style opticalwaveguide.

FIG. 36B is a top view of the ear speculum style optical waveguide ofFIG. 36A.

FIG. 37A is a perspective view of an ear speculum style opticalwaveguide with a side entry light coupling.

FIG. 37B is a top view of the ear speculum style optical waveguide ofFIG. 37A.

FIG. 38A is a perspective view of another alternate ear speculum styleoptical waveguide.

FIG. 38B is a top view of the ear speculum style optical waveguide ofFIG. 38A.

FIG. 39 is a cutaway view of the optical waveguide of FIG. 38A.

FIG. 40 is a cutaway view of the optical waveguide of FIG. 36A.

FIG. 41 is a perspective view of a separable waveguide.

FIG. 42 is a cutaway view of the optical waveguide of FIG. 41.

FIG. 43 is a cutaway view of an optical waveguide with an extendedreflecting surface.

FIG. 44 is a side view of a combination cannula sleeve and opticalwaveguide.

FIG. 45 is a side view of a combination optical waveguide and cannulasleeve with extended elements.

FIG. 46 is a side view of a split combination optical waveguide andcannula sleeve.

FIG. 47 is a side view of a split combination optical waveguide andcannula sleeve with extended elements.

FIGS. 48 and 49 are perspective views of a cannula.

DETAILED DESCRIPTION OF THE INVENTION

The following disclosure generally refers to an optical waveguide andassociated elements for conduction of light. This discussion is forexample and the following disclosure may also be suitable for anyelectromagnetic radiation. The cross-sections illustrated are generallycircular and may also adopt any suitable geometry.

Referring now to FIG. 2, optical waveguide system 14 may accommodate anysuitable surgical instrument such as for example, a drill, burr orendoscope 18 which is encased, enclosed or otherwise surrounded byoptical waveguide sheath 16. An optical waveguide sheath according tothe present disclosure is a generally annular or cylindrical shapedstructure and may be manufactured separately and may be a single usedevice. In the event of a failure of an optical waveguide such asoptical waveguide sheath 16, a replacement may be introducedimmediately. One or more flow paths such as flow path 26 may be createdbetween endoscope 18 and optical waveguide sheath 16. Flow path 26 maybe used for any suitable service such as suction, irrigation,ventilation or the introduction of other tools or devices. A waveguidesheath may be subjected to forces during use, such as a prying force,that may weaken or break it. Structural elements such as gussets or ribsmay be added to waveguide sheath 16 in the bore between the sheath andendoscope 18 that serve to strengthen waveguide sheath 16. A film may beadded to the outside of waveguide sheath 16 to secure pieces that maybecome broken during use to prevent the broken pieces from dropping intothe surgical work space. Said film may serve an optical function aswell, e.g., enhancing total internal reflection within the wall ofwaveguide sheath 16.

Surgical devices such as endoscope 18 may be made without anillumination element and thus aperture 20 may be increased withoutincreasing overall dimension 13 compared to dimension 11 of the deviceof FIG. 1. Wall 18A of endoscope 18 may also be perform as opticalwaveguide to improve illumination and may provide an alternate lightpath to enable illumination of different characteristics.

Referring now to FIG. 3, waveguide sheath 28 may be a single generallyuniform element, it may be composed of two or more distinct illuminationpathways forming an apparently singular conduit, or it may be composedof one or more parallel light conducting elements such as light pathelement 24 or light path element 92 of FIG. 14. Moving the illuminationelement from conventional endoscopes to a separate device such as alight conduit such as waveguide sheath 28 permits illumination surface22 to be larger than many conventional illumination elements.Surrounding an apparatus such as an endoscope with the optical waveguidemay provide generally uniform illumination for any orientation of theendoscope or other device.

Referring now to FIG. 4, illumination surface 22 may adopt any suitableconfiguration to provide illumination. For example facets such as facets30 may direct light energy in any selected direction and may be coatedor otherwise treated to introduce filtering for frequency and orpolarization. Microstructures such as microstructures 32 may be used toachieve directed light energy, filtering or other. One or more lensstructures may be coupled to illumination surface 22, or they may beformed in or on illumination surface such as lenses 34. Alternatively,these elements may also be combined.

Using separate light conducting elements such as light path elements 24may permit selective illumination through a waveguide sheath as well asprovide multiple illumination paths for illumination having differentcharacteristics such as polarization, wavelength or intensity. Eachlight path element may include microstructures, facets, lenses or othersuitable treatment on distal face 24A.

In FIGS. 5 and 6 coupling ring 38 is provided to couple light fromfibers 42 into optical waveguide 36. Coupling ring 38 permits rotationof optical waveguide 36 about bore centerline 37 without rotating fibers42. Coupling ring 38 may be made reusable since it includes theexpensive optical fibers whereas optical waveguide 36 may be madedisposable, e.g., as an inexpensive plastic injection molded part usinga suitable optical material such as acrylic or polycarbonate. Couplingring 38 may also include any suitable light coupling structure such ascoupling lenses such as lenses 40, each lens coupling light energy 39from a fiber 42 into optical waveguide 36. The lenses or suitablemicrostructure may be spherical, cylindrical or aspherical ornon-symmetrical depending on the light source. In the case of fiberoptics, a spherical lens may be used to match the numerical apertures(acceptance angle) of the fiber optic and the optical waveguide. Becausea specific cone angle of light exits a fiber optic cable, a matchingacceptance angle should be used for the coupling ring.

Referring now to FIG. 7, light coupling adapter 44 may be used to couplelight energy in through face 46 and directs the light energy aroundaccess channel 48 and through adapter ring 50 into optical waveguide 36.Access port 49 and access channel 48 provide access to bore 35 for anysuitable surgical tool, apparatus or device. Adapter ring 50 engageswaveguide 36 while permitting relative motion of waveguide 36 relativeto light coupling adapter 44. Alternatively, coupling adapter 44,adapter ring 50 and optical waveguide 36 may be contiguous with norelative motion permitted. Coupling ring 50 may also be an element ofwaveguide 36 as well as an element of light coupling adapter 44.

FIG. 8 illustrates arthroscopic illumination system 52 with ahigh-resolution arthroscope 54 disposed therein. The arthroscopicillumination system comprises a cannula sheath 55 adapted to providestructure-guided illumination, a hub 56 and an illumination source 58.The hub may contain one or more valves 60 and be placed in fluidcommunication with a vacuum and/or irrigation source 62. The cannulasheath 55 comprises a biocompatible sterilizable polymer that functionsas a waveguide. The polymer may be transparent or semi-transparent andmay incorporate facets, prisms, microstructures or other suitablecharacteristics.

An illumination source is operably coupled to the hub 56 and placed inoptical communication with the cannula sheath 55. The illuminationsource comprises one or more LEDs 64 (light emitting diodes), a powersource 66, a conductor 68 electrically connecting the power source andthe LED, an LED control circuit 65 and switch 67. The LED is preferablya white-light LED, which provides a bright, white light. The powersource may be provided in any form such as a power outlet or a lithiumion polymer battery. When the illumination source is illuminated, lightfrom the illumination source propagates through the cannula sheath bymeans of total internal reflection, illuminating the distal end 69 ofthe cannula sheath. Light is not emitted, nor does it leak out of theouter diameter surface of the sleeve until the light reaches designatedextraction structures. The outer surfaces of the sleeve may be providedwith metallic or other suitable coating to help prevent light leakagewhile assisting with total internal reflection. The distal end of thesleeve may be provided with a microstructure, optical component or adiffuse finish. Based on the desired optical output, a molded componentor custom finish may be applied to filter or shape the light exiting thesheath.

Alternatively, the illumination source may comprise a conventional fiberlight cable operably connected to the hub. The illumination source maybe placed in optical communication with the sheath through opticalcoupling lenses disposed on the proximal end of sleeve 61 within hub 56.

Referring now to FIGS. 9 and 10, light energy from LED array 72 may becoupled into optical waveguide 70 using reflective and or refractiveoptical assembly 74 in proximal end 70 p such that light energy isprojected from illumination surface 71 on distal end 70 d.

FIGS. 11A, 11B and 11C illustrate an alternate light coupling intooptical waveguide 76. Light 75 may be provided through any suitableconduit such as plastic rod 78. Light conduit 78 may be formed, cut orotherwise shaped at engagement end 79 to reflect light 75 at anysuitable angle relative to light conduit 78. Surface 80 may include anysuitable treatment, coating or microstructure to reflect a suitableamount of light 75 at a suitable angle relative to light conduit 78.

A notch, groove or other suitable indentation such as u-shaped notch 82may be provided in proximal end 84 of an optical waveguide to engage alight conduit such as plastic rod 78. The shape of notch 82 may beselected to optimize light coupling between the light conduit and theoptical waveguide. One or more structures such as reflectors 73 and orfacet 86 may be included in any suitable location of an opticalwaveguide to spread the input light throughout the waveguide and orreflect light into bore 88 or out of the optical waveguide into areassurrounding the waveguide. Light generally exits optical waveguidethrough illumination surface 89. One or more light splitting prisms suchas prisms 73 may be added to a waveguide or to a coupling such ascoupling 81 of FIG. 12 to direct the light around the circumference ofwaveguide 76. Two or more such prisms may be placed in spaced relationto each other to allow some light to spread straight down through thegap between prisms while light hitting the prisms is directed around thecircumference.

Referring now to FIG. 12, optical waveguide 76 may include an alternatelight coupling apparatus such as coupling 81. Coupling 81 may providemechanical support and optical conduit between optical input 83 andwaveguide 76.

Distal end 83 as shown in FIG. 13 includes one of more vertical facetssuch as facet 83F within the distal end to disrupt the light spiralingwithin the waveguide. Also shown are structures such as structure 85 onthe end face of the cannula which serve to direct light as it exits theend face. Shown are convex lenses, but concave lenses or other opticalstructures (e.g., stamped foil diffuser) may be employed depending onthe desired light control. Stepped facets such as facets 87 and 89 areshown on the outside tube wall. The “riser” section, risers 87R and 89Rrespectively, of the stepped facet is angled to cause the light to exitand as a result the waveguide slides against tissue without damaging thetissue. The angle is generally obtuse relative to the adjacent distalsurface. Steps may be uniform or non-uniform as shown (second step fromend is smaller than the first or third step) depending on the lightdirectional control desired. The steps may be designed to direct lightsubstantially inwards and or toward the bottom of the tube or somedistance from the bottom of the tube, or they may be designed to directlight toward the outside of the tube, or any suitable combination. Thefacets such as facets 87 and 89 may be each designed to direct light atdifferent angles away from the waveguide and or may be designed toprovide different beam spreads from each facet, e.g., by using differentmicro-structure diffusers on each facet face.

Facets may be used on the inside surface of the waveguide, but ifwaveguide material is removed to form the facets, the shape of thewaveguide may be changed to maintain the internal diameter of the boregenerally constant to prevent formation of a gap is between thewaveguide and a dilator tube used to insert the waveguide into the body.Said gap may trap tissue, thereby damaging it during insertion into thebody or causing the waveguide to be difficult to insert. Thus the outerwall of the waveguide may appear to narrow to close this gap and preventthe problems noted.

Alternatively, optical waveguide 90 as illustrated in FIGS. 14 and 14a-14 d may be formed using one or more solid light guides such as lightpath element or rod 92 and forming the one or more rods into a springlike spiral. Input 93 may be formed at any suitable angle 94 with anoptimal angle between 45° and 90°. Distal end 95 may be cut or formed tohave any suitable configuration to reflect or emit light in any suitabledirection or directions as illustrated in FIGS. 14 and 14 a-14 d forexample. A spiral waveguide may be mechanically flexible, much as aspring is flexible. The spiral waveguide may be part of an assembly thatincludes rigid or semi-rigid tubular waveguides interconnected by spiralwaveguides. Either or both of the tubular and spiral waveguides may havelight extraction structures.

Surgical illumination system 100 may include optical waveguide 96 andlight adapter 98. Distal end 99 of light adapter 98 may have anysuitable shape as illustrated in FIGS. 17a-17c . Lenses or other opticalstructures such as lenses 102, 104, 106 and 108 may have any suitableshape or orientation to optimize light coupling, extraction or output.Different lenses may also be combined on a light adapter as in FIG. 17a. A complimentary surface 110 may be produced in optical waveguide 96 toachieve selected light transfer or coupling.

Alternatively, light adapter 98 may extend through optical waveguide 96such that lenses such as lenses 102, 104, 106 and or 108 directlyilluminate bore 105 and or the surgical site.

An optical waveguide may also be used with any suitable end cap engagingthe distal end of the optical waveguide. The end cap may or may not beused to modify or reflect the illumination energy. Similarly, shims maybe used within the optical waveguide to orient any tool or tools withinthe waveguide and the shims may or may not conduct or modify theillumination energy.

Referring now to FIGS. 18, 19 and 20, applied light energy may bebifurcated to send light into wall 123 of tube 125. Light input 120 maybe split in input coupling 122. The input coupling may be a solidplastic or may consist of a bundle of optical fibers. Optical fibers maybe preferred because it is then possible to combine the waveguide andthe optical fiber bundle, typically a separate cable used to conductlight from a light source to the waveguide, as one single device therebyeliminating the need for the user to maintain separate fiber opticcables. The optical fiber input 120 may also be provided as a short“pigtail” section, typically less than two feet long, to which astandard optical fiber cable attaches. The optical fibers may be insertmolded with the waveguide or may be glued into corresponding holes inthe waveguide using a suitable index-matching adhesive. The holes mayinclude a collar section or other technique to provide strain relief.Typically, fiber bundles are made round. In a preferred embodiment, theoptical fibers at the end to be coupled into the waveguide are shaped tomatch the waveguide, which may not be circular. For example, the sectionof the tube waveguide into which the optical fibers go may beapproximated as a rectangular profile. Shaping the optical fibers into amatching rectangular profile simplifies the resulting optical designbecause the light dispersion from the optical fibers already conforms tothe shape of the waveguide.

The bifurcated ends 122A and 122B of input 122 preferably enter tubewall 123 at an angle 124 to start directing light around the tube wall.Alternatively, the bifurcated ends 122A and 122B may each enter tubewall 123 at different angles to further control light distribution. Thebifurcated ends may enter the tube wall orthogonally, but this mayrequire a prism structure in the wall placed between the input and theoutput with the apex of the prism pointed at the input. The prismstructure directs the light around the tube wall. A vertical prismstructure, prism 126 is shown with apex 126A of the prism pointed intoward the center of the tube. Prism structure 126 may direct a portionof the input light back underneath the inputs and contributes todirecting light all the way around the tube wall. The position, angleand size of this prism relative to the input bifurcated end determineshow much light continues in the tube wall in its primary direction andhow much light is reflected in the opposite direction in the tube wall.

Additional vertical prism structures or light disruption structures maybe placed toward the bottom of the tube on the outside tube wall asshown in FIGS. 18, 19 and 20. One or more light extraction structures128, shown as circumferential grooves cut into the outside wall of thetube, may also be included to optimize the illumination provided belowwaveguide 125. Light 127 traveling circumferentially in the tube wallwill not strike the light extraction structures 128 with sufficientangle to exit waveguide 125. Thus, vertical prisms or light disruptionstructures such as disruption prisms 130A, 130B, 130C and 130D may benecessary to redirect the light so that the light rays will strike thelight extraction structures and exit the tube wall to provideillumination. As shown in FIG. 20, vertical prism structures such as130A and 130B have different depths around the circumference in order toaffect substantially all of the light rays traveling circumferentiallyin the tube wall. Vertical prisms of constant depth would not affectsubstantially all of the light rays.

FIG. 19 also illustrates how a half-tube may be formed to provideillumination. At least one half-tube illuminator may be attached to theend of at least one arm of a frame, such as that used in Adson, Williamsor McCulloch retractors. Such frames typically include two arms, butsome frames have more than two arms. The arms of the frame are thenmoved apart to create a surgical workspace, with the at least onehalf-tube illuminator providing illumination of said space. One or morehalf-tube illuminators may also be provided with an extension thatpreferably is in contact with the opposite half tube and that serves toprevent tissue from filling in the gap created when the half tubes areseparated. Tissue may enter this gap and interfere with surgery, so theextension helps reduce that issue. The extension is preferably thin andflexible, for example, a thin section of plastic molded or otherwisesecured to the waveguide or a thin section of metal or other suitablematerial attached to the waveguide.

FIGS. 21 and 22 illustrate alternative configurations of an illuminationwaveguide. Proximal reflecting structures such as proximal structure 132and proximal structure 134 may provide more complete control of thelight within the waveguide with an associated weakening of thestructure.

Referring now to FIGS. 23 and 24, cross-sections 135 and 137 illustrateadditional alternate light extraction structures of the distal end of anillumination waveguide. As shown with respect to FIG. 13 above, depth136 of light extraction structures such as structures 138 and 141increases relative to the distance from the light input in order toextract most of the light and send the light out the inner tube wall 139toward the bottom of the tube or distal end 140 and for some distancebeyond the distal end. The light that remains in the tube wall below theextraction structures exits the bottom edge 140B, which may be flat ormay have additional optical structures, e.g., a curved lens or a patternof light diffusing structures such as structures 85 of FIG. 13. In FIG.23, the distal 510 mm of the tube wall, window 142, have no structuresto enable this surface to operate as a window to the surrounding tissuesto improve visualization of the surgical space.

It has been demonstrated that a clear waveguide cannula providesimproved visualization of the entire surgical workspace because thesurgeon can see the layers of tissue through the walls, therebyenhancing the surgeon's sense of depth and position, which are difficultto determine in an opaque cannula. Light exiting the side walls at theareas of tissue contact, due to changes in total internal reflection atthese contact areas, serves to illuminate these tissues making them morevisible than if a non-illuminated, non-waveguide clear plastic cannulais used. Alternatively, extraction structures 138 or 141 may extend allthe way down to bottom edge 140B.

Referring now to FIGS. 25-28, light input connector 152C surrounds lightinput cylinder 152 which may be divided into multiple input arms such asarms 151 and 153 that then direct light into illumination waveguide 150.Input arms 151 and 153 may assume any suitable shape and cross-sectionsdepending on the optical design goals, such as the multi-radius armswith rectangular cross-section shown or straight sections (no radius) orangle rotators, etc. Also shown is a clamp flange holder 159 that servesto support input connector 152C and arms as well as providing a standardlight connector 152C over input cylinder 152 (e.g., an ACMI or WOLFconnector) and a flange 159F at the top for attaching a clamp used tohold the entire structure in place once it is positioned relative to asurgical site in a body. A shelf or other similar light blockingstructures may be added to the holder, extending over the input arms andor the upper tube edge as needed to help block any light that may escapethese structures that might shine up into the user's eyes.Circumferential light extraction structures 154 are shown at the bottom,distal end 156, of the tube. In the section view of FIG. 26, verticallight disruption structures or facets 83F are shown on the inside wallof the tube.

Illuminated cannula 150 of FIG. 25 includes clamp adapter 159F that alsosupport light coupling 152C for introducing light energy into cannula150. The relative orientation of the clamp adapter and the lightcoupling as shown enables the clamp adapter to operate as a shield toprevent any misdirected light shining into the eyes of anyone lookinginto bore 150B of the cannula, but the clamp adapter and light couplingmay adopt any suitable orientation.

FIG. 26 illustrates vertical facets 83F within the distal end fordisrupting the light spiraling within the waveguide. Circumferentiallight extraction structures 154 may include stepped facets such asfacets 154F and risers such as riser 154R on the outside tube wall 150W.The “riser” section of the stepped facet section 154R is angled so thatit may slide against tissue without damaging the tissue. Steps may beuniform or non-uniform depending on the light directional controldesired. The steps may be designed to directly light substantiallyinwards and toward the bottom of the tube or some distance from thebottom of the tube, or they may be designed to direct light toward theoutside of the tube, or both.

Circumferential light extraction structures such as structures 154 maybe facets or may be other geometries, such as parabolas. Circumferentiallight extraction structures coupled with light directing structures thatprovide circumferentially distributed light to the extraction structuresprovide circumferential illumination. Since tools entering the interiorof the tube now have light shining on them from all sides, the tools donot cast any shadows within the cone of illumination emitted by thecannula. The circumferential illumination from a cylindrical waveguidecreates a generally uniform cone of light that minimizes shadows, e.g.,from instruments, creating substantially shadowless illumination in thesurgical field below the tubular waveguide.

Cannula 150 of FIGS. 27-30 is illustrated without clamp flange/holder159 in place. Input arms 151 and 153 are offset above proximal surface161 by a distance 162 and end in angled reflector surface 158 thatpartially extends down distance 160 into the tube wall. The offsetcontrols the light entering waveguide 150 and restricts light enteringto input structure 165. Reflector surface 158 serves to direct lightorthogonally from the horizontal input and down into the tube wall, alsocausing the light to spread around the circumference of the tube wall bythe time the light reaches the distal or lower part of the tube.Reflector surfaces such as surface 158 may be a flat surface, an arcedsurface, or a series of interconnected surfaces and may also end at thetop of the tube wall.

Reflector surface 158 may be treated, e.g., a reflective or metalizedcoating or an applied reflective film, to enhance reflection.

Air gaps may be used to isolate the light-conducting pathway in anysuitable connector. Waveguide 150 of FIG. 29 includes male connector148C that has been integrated with waveguide tube wall 157 via bracket147. This allows connector 148C to be molded with the waveguide and notattached as a separate part, such as standard light connector 152C shownin FIG. 25. A separate connector introduces tolerance concerns into thesystem that may result in reduced coupling efficiency between a fiberoptic cable output and waveguide input 149 because the two parts may notbe aligned correctly. Molding the connector and the waveguide input asone piece substantially reduces the chance of misalignment and therebyincreases coupling efficiency.

FIG. 30 is a front view looking into the input of connector 148C. Airgaps 146 are maintained around waveguide input 149 to isolate thelight-conducting pathway. One or more small zones of contact such ascontact zone 146C may be maintained, essentially bridging connector 148Cand input 149 with a small amount of material, to add strength andstability to the system while resulting in minimum light loss in thecontact zone.

Referring now to FIG. 31, structure 166 along the inside wall may beused for suction for smoke evacuation and or ventilation. Smoke from anelectrosurgical knife may obscure the surgeons view until the smokedissipates. A ventilation tube such as tube 167 may be attached to thetop of structure 166 to engage the suction structure and provide asource of suction or vacuum. The bottom of suction structure 166 may beas shown opening into working channel 170B orthogonal to wall 170W or itmay open directly toward the bottom or distal end 170D by removing lowerlip 166L. The former is preferred to reduce the chance that debris issucked into the suction structure thereby blocking it. One or moreadditional tubes may also be positioned to inject air into the cannulabore, angled along the walls to create a vortex-like air flow that drawssmoke toward the side walls where it can then be evacuated, said airflow serving to clear the smoke sooner from the center of the tube whereit may obscure vision.

Small filters such as debris filter 172 may be included in or nearsuction input 168 to block debris. The lower suction opening, input 168,is preferred to be as close to distal end 170D of illuminated waveguide170 as practical, while not interfering with the optical structures, inorder to evacuate smoke from electrocautery as soon as possible.Multiple suction openings may be provided along the vertical channel ofthe suction section, but these ports should be sized differently,smallest at the top and largest at the bottom so that there issufficient suction at the bottom port. The suction ports and channelshould be designed to minimize turbulence that contributes to noise.Multiple suction structures may be provided. A shelf in clampflange/holder may help secure suction tubing to suction source. Suctiontubing 167 or suction structure 166 in tube 170 may also include one ormore air filters 173, e.g., charcoal filters, to remove the smell of thesmoke and or other airborne impurities.

FIGS. 32 and 33 illustrate details of suction tube controls 174 and 176with sliders 174S and 176S over a tear drop shaped opening 177 tocontrol the amount of vacuum or suction. The irregular shape of openings177 allows finer control over amount of vacuum over a constant shapeopening like a rectangular or oblong opening. Any other suitableirregular may also be used. FIG. 30 shows slider 174S engaged to allowsome suction. Slider 174S is made to go all the way around tube 174Twith a friction fit. A slider such as sliders 174S or 176S may be movedcompletely off of opening 177 to stop suction. FIG. 31 shows slider 176Swith a section removed allowing slider 176S to be simply rotated toexpose opening 177 completely to turn off suction. For control 176,opening 177 can be rotated 90° relative to the orientation of opening177 in control 174. The orientation of opening 177 in control 176enables control of suction by simply rotating slider 176S rather thansliding it up and down as in control 174.

Referring now to FIG. 34, input coupling 180 may incorporate compoundparabolic concentrator 181 or similarly functioning device, such asoptical taper 187 in FIG. 35A, whose input 182 is sized to match thelargest fiber bundle, which is typically 5 or 6 mm in diameter, butwhose output 183 is coupled to a smaller waveguide thickness, e.g., 3 or5 mm. Such a device could be hidden in the connector of the waveguidedevice, e.g., inside of an ACMI connector or other suitable device.

These devices are governed by an equation that relates input and outputarea to the numerical aperture of the light entering and exiting the CPCor taper device. Specifically, the area times the numerical aperture ofthe input must equal the area times the numerical aperture of theoutput. This means that in going from a larger area input such as input182 to a smaller area output such as output 183 to inject light into thewaveguide, the numerical aperture at the output will increase therebyincreasing the angles of the light entering the waveguide. Larger lightangles are more difficult to control inside of the waveguide, resultingin greater light loss in the waveguide and increasing design complexityand cost. Thus, the numerical aperture of an input coupling such ascoupling 180 or 186 should match or be less than the numerical apertureof the waveguide. Any other suitable method may be employed forenhancing light coupling efficiency to a fiber bundle cable whilepreserving etendue.

Input 188 of optical taper coupling 186 of FIGS. 35A and 35B provides asignificant improvement in input coupling occurs by using a square inputcoupler on the waveguide that couples to a typical, round fiber bundlecable. The increase in coupling surface area results in improved lightcoupling for a variety of fiber sizes without the effect on numericalaperture. For example, going from a 4 mm round coupler to a 4 mm squarecoupler results in 27% more surface area for coupling to a fiber bundle.If these round and square coupling faces are coupled to a 5 mm diameterfiber bundle, the percent of the 5 mm bundle that remains uncoupled is36% with the round coupler, but is only 18% with the square coupler.This reduces the light lost by half while having no effect on thenumerical aperture of the light going into the waveguide from thecoupling face. The input square should be sized as close as practical tothe maximum fiber bundle diameter expected. For example, if a 3 mm inputis used to couple to a 5 mm fiber bundle, then the square input providesonly a 10% improvement in coupling efficiency over a round input. Afurther improvement is made by shaping the optical fibers in the fiberbundle cable to match the square input of the waveguide so that thecapture and dispersion of light in the waveguide is optimized.Similarly, any suitable index matching material may also be used, suchas an index matching gel, to improve input coupling.

FIGS. 36A and 36B illustrate an illumination waveguide configured as earspeculum 190. Input 192 is through proximal edge 193 with an angle 191selected to control the angle of circulation of the light within thewaveguide. Light enters the larger diameter upper portion and exits fromat least one light extraction structure at or near the smaller diameterlower portion. The walls of the waveguide are preferably curved, but mayadopt any other suitable geometry.

Alternatively, light input 196 may engage sidewall 195 of waveguide 194as illustrated in FIGS. 37A and 37B. In an input configuration similarto the input of the cannula of FIG. 18 or 25, illumination waveguide 197of FIGS. 38A, 38B and 39 may include a bifurcated input 198 that mayinclude a beam directing prism as described for FIG. 11C.

In the cutaway view of FIG. 39 one or more optical elements such as lens200 may also be included in waveguide 202. Optical elements such as lens200 may also include one or more ports such as port 201 to enable accessfor the insertion of tools, fluid, suction or any other suitablenecessity.

Waveguide 210 of FIGS. 41 and 42 may be split open during surgery topermit greater access to the surgical field. Waveguide 210 may be rigidoptical material, e.g., acrylic or polycarbonate, or may be flexibleoptical material, e.g., silicone, or may incorporate both flexible andrigid elements, e.g. a silicone waveguide hinge over-molded to an upperand lower rigid acrylic waveguide. Light input channels 211 and 213 maybe split and fed through a fiber “Y” or may be comprised entirely ofoptical fibers. Fibers may be embedded into the wall of the wave-guideall the way to lower portion 210L that may incorporate light extractionstructures. Waveguide 210 is fully split front and back from the top toabout ½-⅔ of tube by slots 214 and 216. Alternatively, a waveguide maybe split all the way to lower portion 210L. Lower portion 210L is scoredinside and out with scoring such as score 218. The scoring operates toredirect light stuck circling the tube. The bottom element 220 ispre-split in half along edge 221 and may be glued or otherwise securedin a waveguide such as waveguide 210. The planar shape of element 220permits viewing through bottom element 220 and allows light to shinethrough. Alternatively, element 220 may also adopt any other suitablegeometry such as rounded to form a lens. Because of the interface withthe tube along edge 222 very little light is conducted into element 220.Hole 223 enables a surgical screw or other suitable connector to engagethrough the bottom of waveguide 210 to a surgical site. Splittingwaveguide 210 and bottom 220 frees the waveguide elements from theconnector, and permits the waveguide elements to be removed from thesurgical site. While at least one light extraction structure ispreferably located in lower portion 210L on each tube half, the at leastone extraction structure may be located on only one half or may belocated further up the tube, e.g., near the end of split 216 and orsplit 214.

Waveguide 230 in FIG. 43 has reflector face 232 extending down to theopposite side of tube waveguide 234, effectively removing material 236.Extended reflector face 232 serves to direct light circumferentiallyaround the tube wall. This opens up the waveguide to provide improvedaccess to the surgical space. In addition, it offers the opportunity toreplace removed material 236 with more durable material to improvestrength and or provide the clamp flange holder function and or toprovide mounting for other devices, such as a CCD camera.

Illuminated retractors such as cannula, waveguides, tubes and or sheathsmay also benefit from extendable skirts or segments to prevent tissueencroaching on a surgical site. The extendable elements may also includeinterface surfaces to introduce light into the elements to enhancesurgical site illumination and or provide off axis illumination toenhance shadows for better depth perception and tissue discrimination.

Combination cannula 240 includes waveguide cannula 242 and cannulasleeve 244 as illustrated in FIG. 44. Waveguide cannula 242 conductslight into a surgical space similar to illumination waveguide 150,illumination waveguide 170 or waveguide 230 as discussed above. Cannulasleeve 244 slides over waveguide cannula 242 and provides mechanicalstrength for retracting tissue. Waveguide cannula 242 may be made withwall 242W thinner than the walls of illumination waveguide 150,illumination waveguide 170 or waveguide 230 to allow the combinedwaveguide cannula and cannula sleeve to be used together withoutexceeding wall thickness 150W as shown in FIG. 27.

The illuminated retractors as discussed above may also be madeextendable or telescoping to enable a varying depths of surgery with asingle thus device minimizing hospital inventory. The illuminatingcannulas discussed may also be formed as an illuminating drill guide,either as a tube or as two half tubes, that may be used to hold andguide drill or burr tip while also providing illumination of the areabeing worked on.

An optical waveguide may also operate as a cannula providing irrigation,suction, ventilation or other suitable services for medicalapplications. Suction may be provided via one or more passages withinthe structure of the waveguide or cannula. The suction paths or passagesmay also include any suitable filter media such as charcoal.

An optical waveguide may provide illumination and at the same timeperform as a surgical instrument. Other than rigid endoscopes, devicessuch as trocars, obturators, retractors, may all be made from waveguidematerial. Devices, such as laryngoscope blades can be made out ofwaveguide material and thus be self illuminating thus eliminating anyneed for fiber optics. Use of one or more illumination sources above asurgical field inside the body may provide suitable illumination togenerate shadows from the surgical instruments and thus provide visualfeedback for the surgeons regarding instrument orientation and improvedtissue discrimination.

An optical waveguide may also include one or more coupling lenses may beused to couple light into the optical waveguide. The lenses or othersuitable structure may adopt any suitable geometry such as for examplespherical, cylindrical, aspherical and or non-symmetrical geometries. Ifa light source having a wide output angle such as one or more LEDs isused, a more complex lens system such as an asphere may be used tooptimize light coupling.

One or more faces of an optical waveguide may include a predeterminedmicro structured pattern. Different optical light output shapes or lightoutput directions may be achieved by creating specific structuredsurfaces or patterns. It is also possible to specify microstructuredsurfaces to deflect light as well as focus it into a particular shape.One or more microstructures may be applied to the back and or the frontof a refractive element to deflect the beam as well as shape it.Microstructure surfaces may also be combined with one or more air gapsand or conventional surface shaping to achieve desired opticalperformance. Optical fiber typically has a highly Gaussian outputdistribution that creates a small, bright spot of light that may not besuitable for visualization of a broad surgical area. The implementationof microstructures may create a broader, more uniform distribution oflight thereby allowing comfortable viewing of a broader surgical area.

One or more surfaces in an optical waveguide sheath or adapters orconnectors may be polarized using any suitable technique such asmicro-optic structure, thin film coating or other. Use of polarizedlight in a surgical environment may provide superior illumination andcoupled with the use of complementary polarized coatings on viewingdevices such as cameras or surgeon's glasses may reduce reflected glareproviding less visual distortion and more accurate color rendering ofthe surgical site. One or more surfaces of an optical waveguide sheathmay also include light filtering elements to emit light of one or morefrequencies that may enhance visualization of specific tissues.

Thus, while the preferred embodiments of the devices and methods havebeen described in reference to the environment in which they weredeveloped, they are merely illustrative of the principles of theinventions. Other embodiments and configurations may be devised withoutdeparting from the spirit of the inventions and the scope of theappended claims.

What is claimed is:
 1. A surgical illuminator comprising: a non-fiberoptic optical waveguide for conducting light, the waveguide forming acannula and comprising a proximal portion, a distal portion, an innersurface and an outer surface, wherein the cannula comprises a bore sizedand dimensions to accommodate one more surgical instruments; a lightconducting conduit coupled to the proximal portion of the waveguide, thelight conducting conduit configured to introduce light into thewaveguide, wherein the light conducting conduit conducts light from alight source to the waveguide; and a reflecting element disposed on theproximal portion of the waveguide, the reflecting element configured todirect the light around a circumference of the waveguide.
 2. Theilluminator of claim 1, wherein the reflector comprises a prism.
 3. Theilluminator of claim 1, further comprising a second reflector disposedon the proximal portion of the waveguide, the second reflecting elementconfigured to direct light around the circumference of the waveguide. 4.The illuminator of claim 3, wherein the second reflector is a prism. 5.The illuminator of claim 3, wherein the reflector elements are disposedin a spaced relationship relative to one another to allow the light tospread distally along the waveguide and through a gap disposed betweenthe reflector elements while the light hitting the reflectors isdirected circumferentially around the waveguide.
 6. The illuminator ofclaim 1, further comprising a plurality of light extracting structuresdisposed on the inner or the outer surface of the waveguide, theplurality of light extracting structures configured to extract lighttherefrom.
 7. The illuminator of claim 1, further comprising an opticalfilm disposed on a surface of the waveguide, the optical film enhancingtotal internal reflection in the waveguide.
 8. The illuminator of claim1, further comprising a coating disposed on a surface of the waveguide,the coating adapted to assist with total internal reflection therein andwherein the coating is adapted to help prevent light leakage therefrom.9. The illuminator of claim 1, wherein the cannula is a cylindricaltubular shape.
 10. The illuminator of claim 1, wherein the cannula is atapered tubular shape.
 11. The illuminator of claim 1, wherein the lightconducting conduit comprises a bifurcated light input conduit.
 12. Thesurgical illuminator of claim 1, further comprising a sleeve slidablydisposed over the cannula, the sleeve telescopically adjustable relativeto the cannula.
 13. The surgical illuminator of claim 1, furthercomprising an optical fiber pigtail coupled with the light conductingconduit.
 14. The surgical illuminator of claim 1, further comprising atube coupled with the cannula.
 15. The surgical illuminator of claim 14,wherein the tube is configured to provide a vacuum for smoke evacuation.16. The surgical illuminator of claim 15, further comprising a suctioncontrol element configured to control the vacuum.
 17. The surgicalilluminator of claim 1, further comprising an adapter ring engaged withthe light conducting conduits and adapted to permit relative movementbetween the light conducting conduit and the cannula, wherein theadapter ring couples illumination energy from the light conductingconduit to the waveguide.